Document Type

Article

Publication Date

9-28-2026

Journal / Book Title

ERJ Open Research

Abstract

Background: Acute electronic cigarette (E-cigarette) use has shown adverse cardiorespiratory impacts similar to conventional cigarette (C-cigarette) smoking; however, its early effects remain unclear. We aimed to examine the early effects of E-cigarette use on systemic vascular function, cardiorespiratory responses to exercise and exertional symptoms in young adults.

Methods: 75 healthy active young adults (18–30 years), divided into three age- and sex-matched groups (E-cigarette users, C-cigarette smokers and never-smoker controls; n=25 each, E-cigarette use or smoking duration ≥18 months), underwent an incremental cycle exercise test with standard metabolic, cardiorespiratory, blood lactate and sensory measurements. Brachial artery flow-mediated dilatation (FMD) was assessed using Doppler ultrasound. Blood samples were collected to assess vascular inflammatory markers.

Results: Cotinine (nicotine metabolite) levels were not different between E-cigarette users and C-cigarette smokers (80.7±33.0 versus 65.5±27.6 pg·mL−1, p=0.2). At peak exercise, both E-cigarette users and C-cigarette smokers had lower exercise capacity, oxygen uptake, and ventilation compared with controls (182±31, 178±27 versus 219±43 watts; 35.1±6.4, 35.1±5.3 versus 41.2±5.9 mL·kg−1·min−1; 97.8±24.7, 98.9±21.6 versus 116.1±29.8 L·min−1, respectively; all p< 0.05). Furthermore, E-cigarette users and C-cigarette smokers demonstrated decreased exercise ventilatory efficiency, with higher ventilation, blood lactate, dyspnoea ratings and leg discomfort during submaximal exercise compared with controls. E-cigarette users and C-cigarette smokers showed lower FMD compared with never-smokers (4.7±3.0, 4.5±2.9 versus 8.1±3.5%, p< 0.05), which was inversely associated with vascular cell adhesion molecule-1 and thrombospondin-2.

Conclusion: E-cigarette use and C-cigarette smoking were both associated with early detrimental effects on exercise capacity, ventilatory efficiency, systemic vascular function and amplified exertional symptoms.

DOI

10.1183/23120541.00425-2026

Rights

This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

Published Citation

Faisal, Azmy, et al. “Reduced Vascular Function, Ventilatory Efficiency and Exercise Capacity in Young Adult Electronic Cigarette Users.” ERJ Open Research, vol. 12, no. 5, Sept. 2026, pp. 00425–2026. https://doi.org/10.1183/23120541.00425-2026.

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